Provider Demographics
NPI:1730233271
Name:JENNY S. CHOI OD, INC.
Entity type:Organization
Organization Name:JENNY S. CHOI OD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-957-2704
Mailing Address - Street 1:3930 S BRISTOL ST STE 207
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-7431
Mailing Address - Country:US
Mailing Address - Phone:714-957-2704
Mailing Address - Fax:714-557-4492
Practice Address - Street 1:3930 S BRISTOL ST STE 207
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-7431
Practice Address - Country:US
Practice Address - Phone:714-957-2704
Practice Address - Fax:714-557-4492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2012-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11301T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20531OtherMEDICARE PTAN
CA6371470001Medicare NSC